What Can a CNA Not Do: Scope of Practice Guide

Ever been asked by a nurse to perform a task that made you pause and wonder, “Am I actually allowed to do this?” Understanding what can a CNA not do isn’t just about following rules—it’s about protecting your patients, your license, and your career. The line between helpful and overstepping can be dangerously blurry in busy healthcare settings. This guide will walk you through the specific limitations of your role, help you identify prohibited tasks, and give you the confidence to navigate scope boundaries professionally. Let’s break down exactly where your legal and professional responsibilities end and where you need to draw the line.

Understanding CNA Scope of Practice: The Legal Framework

Your CNA scope of practice isn’t随意 decided—it’s legally defined by state nursing boards, facility policies, and federal regulations. Think of it as your professional playbook: every action you take must fall within these clearly defined boundaries. The legal framework exists primarily for patient safety, but it also protects you from liability and disciplinary action.

Your scope of practice typically includes direct patient care tasks like bathing, feeding, mobility assistance, and vital signs monitoring. However, anything involving medical judgment, sterile procedures, or advanced assessment skills likely falls outside your authority. State regulations vary significantly, so what’s permitted in California might be prohibited in Florida.

Clinical Pearl: Your scope of practice is the MAXIMUM you’re allowed to do, not the MINIMUM. You can always decline to perform tasks that are permitted but outside your comfort level.

The legal foundation comes from three sources:

State Nurse Practice Acts: Laws governing all nursing professionals
State Board of Nursing Regulations: Specific rules detailing CNA duties
Facility Policies: Your employer’s guidelines (which can be MORE restrictive but never LESS restrictive than state law)

When in doubt, remember this hierarchy: Federal Law > State Law > Facility Policy. No policy can legally expand your scope beyond what state regulations permit.

Clinical Tasks CNAs Cannot Perform: Medical Procedures

The boundary between nursing assistant and nursing duties comes down to one critical factor: medical judgment. CNAs perform tasks that don’t require nursing assessment or decision-making, while procedures needing clinical expertise remain squarely in the RN/LPN domain.

You cannot perform these invasive medical procedures:

Wound care beyond basic cleaning: Simple cleansing of intact skin around a wound? Usually fine. Debridement, packing deep wounds, or applying medicated dressings? Definitely not.
Sterile procedures: Starting IVs, inserting urinary catheters, changing sterile dressings, or any procedure requiring sterile technique
Airway management: Suctioning beyond the oral cavity, managing tracheostomies, or adjusting oxygen flow rates
Tube feeding management: Administering tube feedings, checking tube placement, or managing feeding pumps (some states allow basic assistance with direct supervision)

Imagine this scenario: You notice a patient’s surgical incision has a small amount of clear drainage. Your instinct tells you to clean it, but this has crossed from observation to intervention. The appropriate action? Document your observation and report it to the nurse—even if you feel completely capable of handling it yourself.

Common Mistake: Adding medical assessments to your routine measurements. Taking a patient’s blood pressure? Yes. Interpreting whether the reading indicates hypertension? No. Your role stops at measurement and reporting.

Comparison Table: Permitted vs Prohibited Tasks

Task Category	Permitted CNA Actions	Prohibited CNA Actions	Winner/Best For
Wound Care	Clean intact skin around wound, observe and report	Pack wounds, apply medicated dressings, debridement	Document and report all changes to the nurse
Vitals	Measure and record vital signs, report abnormalities	Interpret vitals, make medical decisions based on readings	Accurate measurement and timely reporting
IV Sites	Observe and report signs of infiltration or phlebitis	Adjust IV flow rates, change IV bags, restart IVs	Visual assessment and communication with nurse
Tube Feeds	Position patient properly, observe during feeding	Administer feedings, check placement, manage pumps	Patient positioning and comfort assistance

Medication Administration Restrictions

Medication represents one of the clearest boundaries in CNA scope of practice. With very limited exceptions, CNAs cannot administer medications in any form. This restriction exists because medication administration requires complex clinical judgment, dosage calculations, and assessment of therapeutic effects and side effects.

What you absolutely cannot do:

Administer oral, topical, injectable, or inhaled medications
Crush pills or mix medications
Change medication schedules or dosages
Teach patients about their medications
Document medication administration

Some states allow specific exceptions called “medication aides” or “medication technicians,” but these require additional certification, training, and testing. Even in these roles, the scope is typically limited to passing routine oral medications to stable patients in long-term care settings.

Pro Tip: If you’re asked to “just help out” by giving a patient their routine pills, respond politely: “I’d love to help, but medication administration is outside my scope. Let me get the nurse for you right away.”

Here’s where confusion often arises: You can BRING medications to patients (like handing them their water glass with pills already crushed by the nurse) but you cannot actually PUT the medication in their mouth. You can REMIND patients to take their meds but cannot VERIFY they’ve taken them.

What about over-the-counter medications like Tylenol or lotion? Same rules apply. The route (oral vs topical) doesn’t change the scope restriction—any medication requires nursing assessment and administration.

Assessment and Documentation Limitations

Your role in patient assessment focuses on observation and data collection, not interpretation or clinical judgment. This distinction matters immensely for both legal compliance and patient safety. CNAs excel at noticing changes and reporting them—the “detective” role in patient care—while nurses handle the diagnostic “what it means” aspect.

Assessment tasks you CAN perform:

Measure and document vital signs
Observe and report physical appearance changes
Record intake and output
Note patient behavior and mood changes
Report patient complaints verbatim
Document care provided and patient response

Assessment tasks you CANNOT perform:

Interpret assessment findings
Make nursing diagnoses
Develop care plans
Determine the significance of symptoms
Medical-type documentation (beyond basic charts)

Clinical Pearl: Document what you see, hear, and the patient’s exact words—not your interpretation. Instead of “Patient seems depressed,” write “Patient states, ‘I feel sad all the time’ and avoided eye contact during conversation.”

Documentation follows similar boundaries. You should document the care YOU provided and observations YOU made, but never document nursing assessments, medication administration, or care you didn’t personally deliver. Charting errors or omissions can have serious consequences—if you didn’t do it, don’t chart it.

Patient Care Decision-Making Boundaries

CNAs make countless decisions every shift—about prioritizing tasks, time management, and how best to assist patients. However, clinical decision-making about patient medical care remains firmly within nursing scope. This protects patients from well-intentioned but potentially harmful actions made without proper assessment and clinical judgment.

Examples of appropriate CNA decision-making:

Which patient needs toileting assistance first
How to safely transfer a patient using proper body mechanics
Whether to request additional help for a two-person assist
When a patient change requires immediate nurse notification

Examples of prohibited CNA decision-making:

Determining a patient doesn’t need pain medication because they “seem fine”
Deciding not to report symptoms because they’ve “always had that”
Changing care routines without nursing instruction
Prioritizing patients based on your own assessment rather than the care plan

Key Takeaway: Your judgment about HOW to perform tasks within your scope is valuable and expected. Your judgment about WHAT medical care patients need is not.

Imagine you’re caring for a post-operative patient who usually requests pain medication every 4 hours. Today, they say they’re comfortable and don’t want anything. You might think they’re doing better and decide not to mention this to the nurse. But this decision crosses into clinical assessment—perhaps they’re too confused to recognize pain, or perhaps their pain tolerance indicates a concerning neurological change. Always communicate significant changes from the patient’s normal pattern, even when they seem positive.

What to Do When Asked to Exceed Your Scope

Being asked to perform tasks outside your scope can put you in an incredibly difficult position. You want to be helpful and prove your competence, but you also need to protect yourself and your patients. Knowing how to respond professionally yet firmly is a crucial skill for every CNA.

When asked to exceed your scope:

Pause and assess: Quickly determine if the request truly falls outside your scope
Respond politely but firmly: “I’m not able to perform that task, but let me get someone who can”
Explain briefly: “That’s outside the CNA scope of practice” (no lengthy justification needed)
Notify your supervisor: If requests continue or seem inappropriate, document and report
Support the team: Find appropriate assistance immediately rather than leaving the need unaddressed

Pro Tip: Keep a small reference card with your state’s specific scope limitations in your pocket. Having the written authority can help you respond confidently to inappropriate requests.

Different situations require different approaches:

With a nurse you trust: “I’m not certified to do that procedure. Could you show me how to assist properly instead?”

With a new or temporary nurse: “I’d be happy to help, but that’s outside the CNA scope. Let me get our charge nurse to assist.”

With persistent requests: Document the specific instances, times, and circumstances, then discuss with your manager or director of nursing.

Remember, refusing inappropriate requests doesn’t make you difficult—it makes you professional. The best CNAs know their limits precisely and advocate for safe practice.

State-Specific Variations in CNA Practice

One of the most confusing aspects of CNA scope is that it varies significantly by state. Something perfectly legal in Texas might constitute scope creep in Arizona. These differences reflect varying state approaches to healthcare delivery, workforce needs, and patient safety priorities.

Common state variations include:

Medication aide certification: Some states allow CNAs to become certified medication aides
Blood glucose monitoring: Permitted with special training in some states, prohibited in others
Ostomy care: Basic ostomy site care allowed in certain states
Tracheostomy care: Some states permit basic maintenance while others prohibit any trach care
Nail care: Diabetic nail care restrictions vary significantly
Wound care: Simple dressing changes sometimes allowed with additional training

Between you and me: Many CNAs learn boundaries through workplace culture rather than official regulations. Just because everyone at your facility does something doesn’t mean it’s within your legal scope.

For example, if you move from California to New York, you might discover tasks you performed routinely are no longer permitted. The converse is also true—don’t assume restrictions from one state apply everywhere. Always verify your new state’s specific requirements.

Your verification checklist should include:

[ ] Your state’s Nurse Practice Act and CNA regulations
[ ] Your facility’s policy manual (often more restrictive than state law)
[ ] Your job description and orientation materials
[ ] Any certifications or additional training you’ve completed
[ ] Recent updates or clarifications from your state board

When in doubt, contact your state Board of Nursing directly—most have helplines or clear online resources about scope questions.

Consequences of Scope Violations

Exceeding your CNA scope isn’t just a technical violation—it can have serious consequences for your career, legal standing, and most importantly, patient safety. Understanding these potential outcomes reinforces why staying within boundaries matters so much.

Professional consequences can include:

License/certification action: Suspension, probation, or permanent revocation
Termination: Immediate dismissal from your position
Difficulty finding future employment: Negative references and employment record
Loss of credibility: Damage to your professional reputation

Legal consequences might involve:

Civil liability: Lawsuits if your actions harm patients
Criminal charges: In cases of serious misconduct or patient harm
Mandatory reporting: Requirement to disclose violations to future employers
Insurance issues: Personal liability insurance may not cover unauthorized acts

Common Mistake: Assuming “no harm, no foul.” Even if your action doesn’t injure a patient, violating scope can still result in disciplinary action and license consequences.

The most serious consequence, however, is patient harm. Every scope restriction exists because the task requires skills, judgment, or knowledge that you haven’t been trained to provide. When well-meaning CNAs exceed their boundaries, patients can suffer misdiagnosis, delayed treatment, or direct injury.

Real-world example: A CNA in Oregon noticed her patient’s leg looked swollen and red. Instead of reporting it, she applied warm compresses—something she’d seen nurses do for other patients. Two days later, the patient was diagnosed with a DVT that had traveled to the lungs. The CNA’s intervention had likely promoted clot dislodgement. She lost her certification and faced a malpractice lawsuit.

Common Questions About CNA Scope Limitations

Q: Can I perform tasks if a nurse is supervising me directly? Even with direct supervision, you cannot perform tasks outside your legal scope. Supervision doesn’t expand your certification boundaries—the nurse would need to perform the task themselves.

Q: What about during emergencies? In true emergencies, you may perform reasonable actions to prevent imminent harm, but these should be limited to basic life support measures you’re trained for. Anything beyond merits immediate professional medical intervention.

Q: Can I be fired for refusing to do something outside my scope? No. You’re legally protected when refusing to perform tasks outside your scope. Document the refusal and situation if necessary, but you should face no retaliation for appropriate boundary-setting.

Q: Do volunteer CNAs have different scope limitations? Volunteer status doesn’t change scope limitations—if anything, volunteers should be MORE cautious about performing tasks within their certified scope only.

Q: What if my facility requires tasks prohibited in my state? This creates a serious compliance issue. Document the request, discuss with management, and contact your state Board of Nursing if necessary. No facility can legally require you to violate state regulations.

Conclusion & Key Takeaways

Understanding your CNA scope boundaries protects everyone—most importantly your patients. Your role is vital and valuable precisely because focus on direct care allows the nursing team to handle complex medical tasks. Remember these key points: you can observe and report but not interpret or diagnose; you can assist with medications but not administer them; and you can always say no to inappropriate requests while still supporting excellent patient care. Knowing what can a CNA not do demonstrates professionalism and dedication to safe practice, not limitation. When in doubt, pause, verify your scope, and prioritize patient safety over proving capability.

Have you ever been asked to perform a task outside your CNA scope? Share your experience in the comments below—your story could help another CNA navigate a similar situation!

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